There is no doubt that the majority of us do not engage our core properly and this sets the stage for back pain and other issues in the body. The core area (between the ribs and the pelvis) is one of the most important areas to be strengthened but there are some problems with simply starting to strengthen the core.
First we need to understand the area we’re talking about. The core is essentially the abdominal area. It is bordered at the top by the thoracic diaphragm, the bottom by the pelvic diaphragm, the front and sides by the abdominal muscles, and the back by the lumbar vertebrae. We have been taught that if we can engage the core it will help to decrease our back pain because it helps to support the vertebrae. While this is not incorrect, it is not entirely true.
Think of the core like an inflated balloon. Because the balloon is a closed container, when you compress the balloon from front to back it will elongate from top to bottom. In the body if we activate the abdominal muscles properly we will compress the abdominal contents from front to back, and the increase in pressure will partially suspend the lumbar vertebrae therefore providing them with support. Much like the elongation of the balloon, this takes pressure off any of the nerves in the low back area that can cause pain when compressed. Makes sense and in some of us it can happen this way.
The problem with this model is that it completely ignores what is happening to the inside of the “balloon” – the entire abdominal area containing the organs, viscera, and the layers of connective tissue that surround them. Remember that connective tissue can become tight. When it does it will compress the spine and limit the ability of the core muscles to suspend the spine. It is a very difficult job to now simply strengthen weak core muscles to alleviate the back pain you are experiencing even though that is an important part of the equation in the rehabilitation of your back. What needs to happen is a change in focus of your rehabilitation. Decrease the tension in your abdominal connective tissue – manual therapy, yoga, fascial stretching techniques, etc. – will all help to alleviate this tension. Once you have better mobility in the abdominal connective tissues your core strengthening will become more effective, you will engage your core more easily, and you will be able to support your lumbar spine appropriately and decrease pain.
If you are currently experiencing issues in your body that may be due to poor core stability (chronic low back pain, chronic neck or leg pain, bloating after meals to name a few) but have not been able to find any relief with therapeutic interventions, it’s time to ask yourself if anything is missing from your rehabilitation. All potential barriers to your rehabilitation need to be explored in order to be corrected properly (view articles about compensation, and structure and function). If tension affecting the mobility of an area of the body is not addressed, strengthening will never be complete. This is as true in the core as any other area of the body. The first focus of your rehabilitation should be increasing range of motion by addressing all potential restrictions, then progress into strengthening.